5586004 INCREASE IN HEMOGLOBINOPATHIES CARRIAGE AMONG PREGNANT WOMEN IN GERMANY PREDICTED BY MIGRATION AND BIRTH DATA ANALYSIS
Authors: D. Hakimeh, L. Oevermann
Journal: HemaSphere (2023)

Background: Germany is one of the most densly populated countries in Europe, yet it has low allele frequencies for hemoglobinopathies in its population. According to estimates by Kohne et al. (2010), approx. 0.48%1 of Germany’s population are carriers for at least one hemoglobinopathy. Modell et al. (2007) estimated the proportion of carriers among pregnant women in Germany at 0.54%2. Given the sharp increase in migration between 2014 and 2016, predominantly from high prevalence countries for hemoglobinopathies (Figure 1), we expect a rise in carrier numbers among present German population. Although new-born screening for sickle cell disease has been introduces as standard of care in Germany in 2021, low awareness for hemoglobinopathies among general medical staff in general and the lack of existing routine screening in later life, e.g. during pregnancy, still pose a major challenge to monitor the development of these disorders and to ensure appropriate clinical care and consulting services.Aims: To estimate hemoglobinopathies carriage rates among pregnant women in Germany during the last decade. Methods: We extracted data on number and origin of foreign women at childbearing age (15 - 50 years) between 2010 and 2020 in Germany by federal state and year3 from the GENESIS database of the German federal statistical office. Using the published data by Modell and Darlison on carriage rates in pregnancies by country4, we calculated the proportion of women at childbearing age with risk for carrying a hemoglobinopathy per state and year. With the help of data on life births by mothers’ citizenship status (German or foreign)3, we calculated a fertility adjustment factor (= fertility rate of all foreign women/ total fertility rate in Germany, both per state and year) and estimated the yearly proportion of pregnancies at risk for carrying a hemoglobinopathy per state. Results: The estimated hemoglobinopathies carriage rates among pregnancies showed an increasing trend in all 16 German federal states in the last decade (Figure 2). The states Bremen, Hamburg, Berlin, and Hesse showed the highest carriage rates in 2020 with 3.84%, 2.78%, 2.66% and 2.64% respectively (HbS heterozygosity included). Notably, the states with lowest estimated carriage rates in 2020 (Thuringia, Saxony, Saxony-Anhalt and Brandenburg) showed the strongest increases compared to its initial rates in 2010 (Figures 2-4). On a national average, we calculated an increase of approximately 60% in pregnancies at risk for hemoglobinopathy carriage (Figure 5).Conclusion: Our analysis indicates a clear and strong increase in hemoglobinopathy carriage rates among pregnancies in all federal states in parallel to the increase in migration into Germany between 2014 and 2016. Further studies are required to verify these findings and to evaluate the necessity of new public health measures as prenatal screening and consulting services for hemoglobinopathies in Germany. References 1. E. Kohne, E. Kleihauer (2010). Hemoglobinopathies: a longitudinal study over four decades. Deutsches Arzteblatt International, 107(5), 65. 2. B. Modell, M. Darlison, H. Birgens, H. Cario, P. Faustino, P. C. Giordano, B. Gulbis, P. Hopmeier, D. Lena‐Russo, L. Romao & E. Theodorsson (2007) Epidemiology of haemoglobin disorders in Europe: an overview, Scandinavian Journal of Clinical and Laboratory Investigation, 67:1, 39-70. 3. Statistisches Bundesamt (Destatis), Genesis-Online, URL: https://www-genesis.destatis.de/genesis/online, retrieved on: 15.04.2022, Datenlizenz by-2-0 4. “Modell’s Haemoglobinopathologist’s Almanac”, URL: http://www.modell-almanac.net, retrieved on: 18.09.2021 5. Bundesamt für Migration und Flüchtlinge (2021), BAMF. “Aktuelle Zahlen. Asylanträge und Entscheidungen nach den zugangsstärksten Staatsangehörigkeiten im Berichtsjahr 2020.” retrieved on: 24.06.2021.